Provider Demographics
NPI:1023178530
Name:BARKER, RODNEY JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:JAY
Last Name:BARKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3917 WEST ROAD
Mailing Address - Street 2:SUITE #125
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544
Mailing Address - Country:US
Mailing Address - Phone:505-661-3030
Mailing Address - Fax:505-662-9024
Practice Address - Street 1:3917 WEST RD
Practice Address - Street 2:SUITE #125
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-2275
Practice Address - Country:US
Practice Address - Phone:505-661-3030
Practice Address - Fax:505-662-9024
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2004-0528208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM13282344Medicaid
NM900521294OtherMEDICARE GROUP
NM13282344Medicaid